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24A-251 (3) iy'241003:06p p,1 • The Commonwealth of Massachusetts Department of Industrial Accidents �-• Office of Investigations 4 600 Washington Street y Boston, MA 02111 • -,44,04.-- www. mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A t .licant Information Please Print Le' ibl Name ( BusinessfOr ganization/Individual): j' / //e Address: / 3 e4i vi .3 City /State /Zip: c - reic-r) t F f /V( 'J/ O/ Phone #: '7//3- 77 a/5:3 Are you an employer? Check the appropriate box: Type of project (required): 1. al I am a employer with 7° 4. ❑ I am a general contractor and I employees (full and /or part- time)." have }tired the sub contractors 6 • ❑ yzw construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7_ ❑ Remodeling ship and have no employees These sub - contractors have S. ❑ Demolition working for me in any capacity. employees and have workers' y Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 1 L Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152 §1(4), and we have no �� employees. No workers' l3.f Other/{C"0/Wee ea; 0 comp. insurance required.] e V rid Lao N s ''Any applicant that checks box #1 musr also till out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors rust submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. l f the sub - contractors have employees, they must provide their workers' comp. policy number. I sin an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. ) ! !�^�_ Insurance Company Nantc: �"r �.e�Cl i 4 7 � /n S u r Xn CC' W !^ Policy or Self -ins. Lic. W f?: _ �? 0d 6 /' 70 5/J Expiration Date: (7/- ate- Job Site Ad dress :` I { /�} { lvr >,- l 1 h'ti City /State;Zip: ()'r �((, /V1�1 0 /c Attach a copy of the workers' compensation policy declaration page (showing the policy number and expifation date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1.500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under the ins and penalties of perjury that the information provided above is true and correct. Siunature: ; °A �i. ' - ] Date: r ' Z ' /U Phone;?!: \ ( ' ` Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: PELLA PRODUCTS INC 155 MAIN STREET GREENFIELD, MA 01301 - 4 C GIL) ,sl rre l ac h In, MA 0 (% 0 Subject: Disposal of Debris The purpose of this letter is to certify that all the debris resulting from any project undertaken by Pella Products Inc. in your Town will be transported to a dumpster at our main facility at 155 Main Street, Greenfield, MA. Pella Products Inc.is under contract with Waste Management of Massachusetts for the disposal of the contents of this dumpster. Very Truly Yours, PELLA PRODUCTS INC. John P. Benjamin Accounting Manager Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Phone: 413- 772 -0153 Cell: 413- 834 -8799 To: Building Inspector From: David White — Installation Manager Date: May 26, 2010 SUBJECT: Building Permit Applications & Designees Pella Products Incorporated is in the business of replacing windows and doors for our customers. Our process includes providing a building permit for each and every project. I am a licensed Construction Supervisor. Building permits will be applied for using my CSL #091496 and our HIC, # 142279. Please find a copy of my licenses below. Ni s��N Itws atlti - fa sttrila t:l Rat MOIL.. -�iei‘ Restelcsed to. 30 K. rf ft ,4 I t +hIt. a f kitAiNHIS Mitt t„tndi,rr ,+ HO - tlertetrictrd Ln, !r lG- 1 2 Family tkrer% Yda tetra. #s,.;i lRo. MI . ' . :t , ^ , DAV " +0 C WHITE CAR ENTER 5T te c Vellum. to poems% a cermet million ut the 64 .. Mas e�t a+ utt, `tote Budding t ode ORANGE MA 3'304 , is oleo,. her rrrncaltos rd rhos license ,. '7...1 Refer Ili: %% e 71.174 ,. 1'41 zaa n "' Office of Consumer Affairs & Business Regulation License or registration valid for individul use only 'I. OWE IMPROVEMENT CONTRACTOR before the expiration date. If found return to Office of Consumer Affairs and Business Regulation i l',- ,= Registration: t42279 Type: 10 Park Plaza -Smite 5270 I =w Expitekontt rlf2012 Supplement t ;Ind Boston, MA 02116 PELLA PRODUdTS, IOC,, 155 MAIN STREET ,s l..----pe9..A.. 1 J , y iVi '41) GREENFIELD, MA 01301 undersecretary Not valid without signature Each installation will be staffed by our installers who are all licensed in accordance with current building codes. Following are copies of their current licenses. Please accept these individuals as my Designees. Richard Guilmette CS60082 Tim Schrocki CS60927 Lorne Befit CS101355 Curt Boyle CS78514 Brian LaCroix CS65214 Jeff Pollock CSSL100327 Duane Cortis CS092246 Scott Bowdish CSSL100232 Paul Pellerin CSSL100325 Willard Brown CSSL100231 Mark Courtemanche CSSL100233 If you have any question please contact me using the numbers listed above. - 1 - • Building Inspection Services • 1, e ©r l e t7 u c / J , as property owner, give permission to Our contractor, Pella Products Inc., to obtain a building permit for the installation of windows or doors in my home, located at I a 7 IV_ )tioe cQ lc" 6O . Please accept this letter in place of my signature on the building permit application. Thank- You F Fto v c k Jr_ Print Customer Name Home Owner's Signature /ID Date Thank -You . . ^ , , . | Future Sample ��@�� Pre-Renovation ��r�� . Sample _ _ -' ~ _ _ : TNeaample form may i� used Ly renovation firms to docmmentmmpliancavviththe : FE..doral pre-renovation education and renovation, repair, ,Et.nd painting mgoiatkna, , Occupant Confirmation | O�| have e"e,e�da copy cx the lead hazard inKxmauo.n pamphlet imomVnOmedthe | xal risk mMe lead hazard exposure from paxovaionacVvK � activity to mydwamngunit |paoeive0 This pumphle.t before the work began. . C ywnepoccupm`t Opt-out Acknowledgment | - � V� | conhr:� that 1 onn and |ive in th|s omper�y. U`ai d u nu�h!|ndert��/a ageo�6 ea,Uen he'e, let no f:nagnmn woman emNeo here, and that this pmpeTtyis not | ch|N-oczupieg(adity. | Note: AnN|Jrua�eaint|`a i �encerfhioor her uu�oo�|pu/anr.|aga/ ' gvauiae.fosimrpmemn.o.ixkxna|oan/akeriftheohiW| tinn*at the care ukmtresidence. Nete:A child- |iyioapm'1S78 building visited regularly L� the same child. under 6 years m age oil euieas two different days within ally week, mrutleast 3 routs each day, provided that the via\tn total ac|eog60 hours annually, ' |f Box Ais checked. c)erk either Box BorBux0.ti)uL not hoth | 'Li (EV|naquea|that the renovation ||/m use the|ead-oakaworkpnact!cesrequired ' ( byBFY� RenovN|on. Rspah mid Painting Rule; or | 1(�|um�/��d�k� the �mp�orm|ng��n��on�Un�bau�Wx�� ^ {emci-suK wmrkur ETA's Rono;eWon Repair, eno Painting Rule. ` . �-__- ' /4/ _��_ '�i | Signature �Dwmo,�mupc�t , Signature Date , Renovator's Self Certification Option (tor tenant-occupied dwellings only) | instructions to, Renovator: |[ the lead hazarJ inbona|ionpamphlet was delivered ' }Alt e tenant 090010 was 01 obta yo n cv check the appropriate bnx beim. ' Q Declined -|ue lay That | kewax1uC d bmheKort to deliver thek:;.adkazad ' infonna1ho oarrohiet to the rental dwelling unit !igta0 below o1 the date and time ' in d!oatec 000 tet thc 011(001 ilccnncd b it: Inc 0011 noodi. 10 ■ eettirj, - that I have left a copy ot the parnphiet at the unit, with the occtipal'It. : 0 Unavailable tor signature -| certify Mat | have made u good faith (toil todeliver ' N*|eadhazun1inWroxgonp*n;hkgtntherm/ta|ri*e||ingun8|ixtaUberowyndt)'eu , the occu t V.IdS LlbaVs.lilabEt=3 Lo sign the ccmfirrnatio e o[oept. !1urt i oarU - h y 'dhat ^ ! have /eko copy o/ trio pan /ph!etat tile unit by sliding itunee/ the door orby(8|/in � howpanph�awaok�� __ . ` ^ -______--- _ _ — ' Pdnle0Nanhecd Person Ceif:jngDaliveh," Att D e l ivery Date , -_-_______- � -___- -_ __-_- �___ ' 3�nauxeu(�a son � er N y , g L eau P D e K m6ry ^ — - — � __' �_______' . � | Unit Andress --- ----- | Note Regarding Mailing Option ---- »eanaitenaUvetuUeliverympeeon. you may mail trio ' |oaUhazard |�ormadan pamphlet tothe owner m�0/urtenant PanpN,�muszbem�|eeat � \o�a�aeven days oehz/e renovation, Mailing must bet (1ocumen,ed cot h8oaieo|mai(ing ^ 1:0111 100 9501 niton ' Note: This torn) mncueffective until A0n|2O|O. . . • • SITE RESPONSIBILITIES Customer: & 2or 5 � –I v� � �> Date: jr, / iO • Order #: Signatur-: er: �, ,. Sateslverson'. Priam L+s4cofeski — Signature.. 1 1 50% Deposit required at time of order. 2 Final payment is to be made to installation team on the morning of the last day of installation. 3 If customer will not be present at time of install, payment is to be made prior. 4 Checks returned NSF will be assessed a fee of $50.00b cover fees rcrcurred by Pella Failure to pay your final bill will result in finance charges of 1 -1/2% per month (18% Annual) and legal fees associated in the collection of owed monies. 5 Due to inclement weather or site conditions, it may be necessary to reschedule. rb We tame& and WM rd, guarantee epeciec dates ea days el the weelt ¶o irlatallaVo . 7 Time given to complete a job is an estimate, extension of time is possible 8 An Install appointment will be confirmed at Verification. A courtesy reminder call will be placed 1 week prior. 9 Unforeseen rot repair will be quoted on site as additional work via a Change Order. 10 Substantial completion is achieved when all available products have been installed and are operational. Items such as missing or broken parts and service adjustments are covered by Warranty and do not affect the status of a project from being Substantially Complete. 11 In the event that any products are unable to be installed, the final payment will be recalculated. The cost of eraduits (vat testaie/a wet he subtracted from the. belarv; a dire. A subsequent and final payment equal to the cost of products not installed as scheduled will be due upon final completion. 12 Order is not binding until approved by Pella Products management 13 Pella will secure all necessary Building Permits Type of Installation: New Construction: (tear out installation) [ Completely remove interior and exterior Trim, completely remove existing window frame, install new window in rough opening, re -trim both interior and exterior of window / door. Pocke nstall : (sash replacement, existing frame remains) Remove interior or exterior stops, install new window in existing window frame opening, re -use existing or replace window stops (interior or exterior) Some glass loss will occur. Lead Pain Discloser: #1 ! Home was built prior to 1978, Lead Paint discloser has been signed and "Protecting Your Family From Lead in Your Home" brochure has been given to Home Owner #21 1 Are there children under the age of 6 or women who are pregnant? Pella Will Owner WM X Authorized to install Yard Sign on 1st day of installation and remove 7 days afterward X Ensure someone over age 18 is present at all times while Pella employees are in the home. Deliver and unload products n Place drop cloths in work areas F^ 1 1 1 Remove & reinstall interior and exterior trim if applicable [ X 1 [l R emove & reinstall existing shutters and awnings by contract 1 X1 [] R emove existing product and adjust or modify opening as needed [i P rovide all equipment necessary to install products 1 X1 n t ut all wood and other materials outside of home ' X1 n Install all products purchased - 4 X 1 1 I Insulate and caulk around products 1 X1 1 1 Remove stickers and perform initial cleaning of all glass surfaces X [ [ S Demonstrate proper operation di prodhtts 4 X ( [ [ Confirm that all products are in working order l ^ 1 1 1 Remove drop cloths, vacuum and remove all old products from premises 1 1 Finish (paint or stain) product purchased X1 Cut -back or tie trees, bushes, shrubs from exterior wall [ ^ 1 Arrange to have alarm system disconnected and reconnected 1 1 [ X1 Arrange to have any plumbing or electrical repairs or changes by For all service needs, appropriate licensed contractor p4aaaa call. (500) 957 - 3552 1 X I Remove and reinstall existing window treatments, wall hangings and Please make sure you air conditioning units. mention that your project 1 1 I "1 Remove and reposition furniture in work area was installed by Peffa and reference your order n Secure pets in a safe manner number 1 X Remove valuable / breakable items from work area Pit ! Remove snow from area of worl<site if necessary Customer: George Houck Project Name: Houck George 197 N Elm Street Northampton MA Order Number: 739 Quote Number. 2096594 01060 Clear opening (egress) information does not take into consideration the addition of a Rolscreen for any other accessory] to the product. You should consult your local building code to ensure your Pella products meet local egress requirements. Per the manufacturer's limited warranty, unfinished mahogany exterior windows and doors must be finished upon receipt prior to installing and refinished annually, thereafter. Variations in wood grain, color, texture or natural characteristics are not covered under the limited warranty. Refer to Pella Corporate Warranty This form constitutes a contract between Buyer and Seller. Prices are subject to change anytime after 30 days following date of estimate and does not guarantee availability of any product listed. Pella Products Inc. management has final authority on acceptance of this order. Your signature confirms the accuracy of the product(s) chosen. Pella Products assumes no responsibility for accuracy of take offs from drawings or blueprints or that the products listed will be sufficient to complete customer's intended project. The Buyer agrees that the product(s) listed herein are correct, final and cannot be changed, returned or canceled. Deposits are partial payment of the contract and are not refundable. The Buyer agrees that if paying by credit card that authorization is granted to the seller to debit the Buyers credit card by signing this contract. The Buyer agrees that payment discounts do not apply when paying with a credit card. A 1 -1/2% SERVICE CHARGE per month (18% PER ANNUM) will be added to all outstanding balance past our stated terms, plus lawyer and account fees for collecting outstanding accounts. The Buyer agrees that the customer delivery date is a realistic estimate of when the product is to be delivered. Items remaining in our warehouse for more than 30 days beyond the agreed to delivery time will be subject to a storage and handling fee of 1% of the net amount of the order ($25.00 minimum charge). The Buyer agrees that the product can be delivered without the Buyer present and agrees to accept the shipping documents as proof of delivery. The Buyer agrees not to hold the Seller responsible for any damage to driveways, sidewalks, trees and overhead wires caused by the Seller's delivery vehicles. The Buyer agrees to examine the product(s) upon delivery and within 7 DAYS OF DELIVERY provide the Seller notice of any discrepancy between the product(s) ordered and the products(s) delivered, including hardware. If the Buyer does not provide notice within 7 days the Buyer accepts the product(s) as is. Project Checklist has been reviewed Order Totals Taxable Subtotal $14,530.18 Credit Card Approval Signature Sales Tax @6.25% $908.14 6 go 1 k / � , � A , /T Non- taxable Subtotal $7,028.00 Customer Name (Please print) Pella Sales Rep Name (Please print) Total $22,466.32 Deposit Received L Amount Due $22,466.32 Customer signature lI Sales Rep Signature 9 p 9 n tur e Date Date For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella. Dri., +e,+ ,,.. 1 t1/1 4 Mill r,..,k.,,• D•,,.,, , + a Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 • Order Pricing Totals Total List Price $20,830.49 Discountable Amount $27,964.42 Discount @ - 3.547% ($738.76) Non - Discountable Amount ($7,133.93) Net Before Payment Discount $21,569.25 Payment Discount Amount $0.00 Net After Payment Discount $21,569.25 Taxable Subtotal $14,353.06 Sales Tax @ 6.25% $897.07 Non - taxable Subtotal $7,216.19 Total (Total Net + Taxes) $22,466.32 Deposit Received $10,004.22 Amount Due $12,462.10 Printed on 10/18/2010 Office Order Copy Page 16 of 16 Customer: George Houck Quote Description: 739 lmpervia 413 - 584 -1100 Order Number: 739J3KL061 Line # Quote Qty PO Qty Description Item Price Ext'd Price 35 1 0 End of Summer Promotion: 25% off Product List Price: ($4,843.00) Location: Rough Opening: 0" X 0" Discount % = Frame Size: Discount $ $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: ($4,843.00) ($4,843.00) Last Revision Date: Line # Quote Qty PO Qty Description Item Price Ext'd Price 40 1 0 INSTALLATION - INSTALLATION List Price: $120.00 Location: None Assigned Rough Opening: Discount % = 0.00 % Frame Size: Discount $ $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Branch Catalog Net Price: $120.00 $120.00 Last Revision Date: Customer Notes: Permit Fee Printed on 10/18/2010 Office Order Copy Page 15 of 16 Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 15 1 1 Impervia, Casement, Impervia, Casement, 26.25 X 84.5, White List Price: $1,661.68 Location: End Discount % = -4.36 g 1 ■ Rough Opening: 26.75" X 85" 1: Non - Standard Size Fixed Casement Frame Size: 26 1/4 X 22 Discount $ ($72.43) ($72.43) • Frame Size: General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Final Wall Depth: Insulated Exterior Color / Finish:White Frame Perimeter (inches): 222 Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (2W2H), White Net Price: $1,734.11 $1,734.11 Last Revision Date: Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Fixed Casement Frame Size: 26 1/4 X 62 1/2 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish:White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (2W5H), White Wrapping Information: Perimeter Length = 222 ", Glazing Pressure = 205. EXTTRIMIO - PVC Ripped for stops Qty 1 MP -7 - Modified Pocket Installation up to 111 -120 Qty 1 UI wlwrap ITS -PVC4 - New interior PVC stop ripped from Qty 1 314 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 Line # Quote Qty PO Qty Description Item Price Ext'd Price 30 1 0 End of Summer Promotion: 25% off Installation List Price: ($2,290.93) Location: Rough Opening: 0" X 0" Discount % = Frame Size: Discount $ $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: ($2,290.93) ($2,290.93) Last Revision Date: Printed on 10/18/2010 Office Order Copy Page 14 of 16 Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 EXTTRIMI0 - PVC Ripped for stops Qty 1 • MP -7 - Modified Pocket Installation up to 111 -120 Qty 1 UI wlwrap ITS -PVC4 - New interior PVC stop ripped from Qty 1 314 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 14 1 1 Impervia, Casement, Impervia, Casement, 28 X 84.75, White List Price: $1,708.34 t 111 111 Location: #14 t 111 Rough Opening: 28.5" X 85.25" 1: Non - Standard Size Fixed Casement Discount % = - 1.51 % 111 Frame Size: Frame Size: 28 X 22 Discount $ ($25.77) ($25.77) 411 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam 16'1 Final Wall Depth: Insulated Inn Exterior Color / Finish:White Frame Perimeter (inches): 226 Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Net Price: $1,734.11 $1,734.11 Last Revision Date: Grille: GBG, No, 3/4" Contour, Traditional (3W2H), White Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Fixed Casement Frame Size: 28 X 62 3/4 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish:White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (3W5H), White Wrapping Information: Perimeter Length = 226 ", Glazing Pressure = 205. EXTTRIMI O - PVC Ripped for stops Qty 1 MP -7 - Modified Pocket Installation up to 111 -120 Qty 1 UI wlwrap ITS -PVC4 - New interior PVC stop ripped from Qty 1 314 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 Printed on 10/18/2010 Office Order Copy Page 13 of 16 Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price • 12 1 1 Impervia, Casement, Impervia, Casement, 29.5 X 85, White List Price: $1,734.11 1 III Location: #12 13 ■ 11 Rough Opening: 30" X 85.5" 1: Non - Standard Size Fixed Casement Discount % = 0.00 % Frame Size: 29 1/2 X 22 Discount $ $0.00 $0.00 I 411 Frame Size: General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam di a Final Wall Depth: Insulated Exterior Color / Finish:White Frame Perimeter (inches): 229 Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (3W2H), White Net Price: $1,734.11 $1,734.11 Last Revision Date: Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Fixed Casement Frame Size: 29 1/2 X 63 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish:White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (3W5H), White Wrapping Information: Perimeter Length = 229 ", Glazing Pressure = 205. EXTTRIMI O - PVC Ripped for stops Qty 1 MP -7 - Modified Pocket Installation up to 111 -120 Qty 1 UI w /wrap ITS -PVC4 - New interior PVC stop ripped from Qty 1 314 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 13 1 1 Impervia, Casement, Impervia, Casement, 28.5 X 84.75, White List Price: $1,721.30 1 111 111 Location: #13 111 Rough Opening: 29" X 85.25" 1: Non - Standard Size Fixed Casement Discount % = -0.74 % 111 Frame Size: Frame Size: 281/2 X 22 Discount $ ($12.81) ($12.81) 411 General Information: Standard, Duracast, Block Frame (3-1/4"), Foam c i a Final Wall Depth: Insulated 7 Exterior Color / Finish:White Frame Perimeter (inches): 227 Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Net Price: $1,734.11 $1,734.11 Last Revision Date: Grille: GBG, No, 3/4" Contour, Traditional (3W2H), White Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Fixed Casement Frame Size: 28 1/2 X 62 3/4 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish:White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (3W5H), White Wrapping Information: Perimeter Length = 227 ", Glazing Pressure = 205. Printed on 10/18/2010 Office Order Copy Page 12 of 16 Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 11 1 1 Impervia, Casement, Impervia, Casement, 37.5 X 84.75, White List Price: $1,877.10 NOM EM Location: #11 fi Rough Opening: 38" X 85.25" 1: Non - Standard Size Fixed Casement Discount % = 0.00 % I1® Frame Size: 37 1/2 X 22 Discount $ $0.00 $0.00 MEM Frame Size: General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam IL .11t Final Wall Depth: Insulated mar■ Exterior Color / Finish:White Frame Perimeter (inches): 245 Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (3W2H), White Net Price: $1,877.10 $1,877.10 Last Revision Date: Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Fixed Casement Frame Size: 37 1/2 X 62 3/4 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish:White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (3W5H), White Wrapping Information: Perimeter Length = 245 ", Glazing Pressure = 205. Installation Notes: At Verification Unit was Sized at 38.25 X 84.5 the Largest Width from the Factory is 37.5 Rip Stops Accordingly EXTTRIMIO - PVC Ripped for stops Qty 1 MP -8 - Modified Pocket Installation up to 121 -130 Qty 1 UI wlwrap ITS -PVC4 - New interior PVC stop ripped from Qty 1 314 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 Printed on 10/18/2010 Office Order Copy Page 11 of 16 Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price • 10 1 1 Impervia, Casement, Impervia, Casement, 37.5 X 84.5, White List Price: $2,007.31 fi��■ 12 II Location: #10 g INN Rough Opening: 38" X 85" 1: Non - Standard Size Fixed Casement Discount % = 0.00 % Frame Size: 37 1/2 X 22 Discount $ $0.00 $0.00 I %In Frame Size: General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam ;I■ Final Wall Depth: Insulated y # Frame Perimeter (inches): 244 Exterior Color / Finish: White Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (3W2H), White Net Price: $2,007.31 $2,007.31 Last Revision Date: Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Right Casement Frame Size: 37 1/2 X 62 1/2 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish: White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Hardware Options: Standard, Standard Roto Operator, Color Matched Screen: Full Screen, InView Grille: GBG, No, 3/4" Contour, Traditional (3W5H), White Wrapping Information: Perimeter Length = 244 ", Glazing Pressure = 205. EXTTRIMI O - PVC Ripped for stops Qty 1 MP -8 - Modified Pocket Installation up to 121 -130 Qty 1 UI wlwrap ITS -PVC4 - New interior PVC stop ripped from Qty 1 314 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 Printed on 10/18/2010 Office Order Copy Page 10 of 16 Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price • 9 1 1 Impervia, Casement, Impervia, Casement, 37.25 X 84.25, White List Price: $2,007.31 I RI. in 110 Location: #9 1: Non - Standard Size Fixed Casement Discount % = 0.00 % Rough Opening: 37.75" X 84.75 Frame Size: 37 1/4 X 22 Discount $ $0.00 $0.00 �� Frame Size: General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Final Wall Depth: Insulated M# Exterior Color / Finish:White Frame Perimeter (inches): 243 Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (3W2H), White Net Price: $2,007.31 $2,007.31 Last Revision Date: Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Right Casement Frame Size: 37 1/4 X 62 1/4 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish:White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Hardware Options: Standard, Standard Roto Operator, Color Matched Screen: Full Screen, InView Grille: GBG, No, 3/4" Contour, Traditional (3W5H), White Wrapping Information: Perimeter Length = 243 ", Glazing Pressure = 205. EXTTRIMI0 - PVC Ripped for stops Qty 1 MP -8 - Modified Pocket Installation up to 121 -130 Qty 1 UI wlwrap ITS -PVC4 - New interior PVC stop ripped from Qty 1 314 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 Printed on 10/18/2010 Office Order Copy Page 9 of 16 Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 8 1 1 Impervia, Casement, Impervia, Casement, 37.25 X 84.25, White List Price: $2,007.31 2I• ■ 111 Location: #8 II Si Rough Opening: 37.75" X 84.75" 1: Non - Standard Size Fixed Casement Discount % = 0.00 it Frame Size: 37 1/4 X 22 Discount $ $0.00 $0.00 Frame Size: General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam c arr Final Wall Depth: Insulated • Exterior Color / Finish:White Frame Perimeter (inches): 243 Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (3W2H), White Net Price: $2,007.31 $2,007.31 Last Revision Date: Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Right Casement Frame Size: 37 1/4 X 62 1/4 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish:White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Hardware Options: Standard, Standard Roto Operator, Color Matched Screen: Full Screen, InView Grille: GBG, No, 3/4" Contour, Traditional (3W5H), White Wrapping Information: Perimeter Length = 243 ", Glazing Pressure = 205. EXTTRIMI O - PVC Ripped for stops Qty 1 MP -8 - Modified Pocket Installation up to 121 -130 Qty 1 UI wlwrap ITS -PVC4 - New interior PVC stop ripped from Qty 1 314 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 Printed on 10/18/2010 Office Order Copy Page 8 of 16 Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price I II II 7 1 1 Impervia, Casement, Impervia, Casement, 37.25 X 84.25, White List Price: $2,007.31 S IR Location: #7 u ■■ 1X Rough Opening: 37.75" X 84.75" 1: Non - Standard Size Fixed Casement Discount % = 0.00 % i a Frame Size: 37 1/4 X 22 Discount $ $0.00 $0.00 • Frame Size: General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Final Wall Depth: insulated 7at Exterior Color / Finish: White Frame Perimeter (inches): 243 Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (3W2H), White Net Price: $2,007.31 $2,007.31 Last Revision Date: Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Right Casement Frame Size: 37 1/4 X 62 1/4 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish: White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Hardware Options: Standard, Standard Roto Operator, Color Matched Screen: Full Screen, InView Grille: GBG, No, 3/4" Contour, Traditional (3W5H), White Wrapping Information: Perimeter Length = 243 ", Glazing Pressure = 205. EXTTRIMI O - PVC Ripped for stops Qty 1 MP -8 - Modified Pocket Installation up to 121 -130 Qty 1 UI wlwrap ITS -PVC4 - New interior PVC stop ripped from Qty 1 314 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 Printed on 10/18/2010 Office Order Copy Page 7 of 16 Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 6 1 1 Impervia, Casement, Impervia, Casement, 37.25 X 84, White List Price: $1,999.80 I ass ME■ Location: #6 g ■EE Rough Opening: 37.75 " X 84.5 1: Non - Standard Size Fixed Casement Discount % = -0.38 REM Frame Size: 37 1/4 X 22 Discount $ ($7.51) ($7.51) SIM Frame Size: General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam * cacti Final Wall Depth: Insulated m ■err Frame Perimeter (inches): Exterior Color / Finish: White I ( Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (3W2H), White Net Price: $2,007.31 $2,007.31 Last Revision Date: Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Right Casement Frame Size: 37 1/4 X 62 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish: White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Hardware Options: Standard, Standard Roto Operator, Color Matched Screen: Full Screen, InView Grille: GBG, No, 3/4" Contour, Traditional (3W5H), White Wrapping Information: Perimeter Length = 243 ", Glazing Pressure = 205. EXTTRIMIO - PVC Ripped for stops Qty 1 MP -8 - Modified Pocket Installation up to 121 -130 Qty 1 UI wlwrap ITS -PVC4 - New interior PVC stop ripped from Qty 1 314 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 Printed on 10/18/2010 Office Order Copy Page 6 of 16 Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 5 1 1 Impervia, Casement, Impervia, Casement, 36.75 X 84, White List Price: $1,985.83 I ii■® ■MO Location: #5 It MIN Rough Opening: 37.25" X 84.5' 1: Non - Standard Size Fixed Casement Discount % = -1.08 % SRI Frame Size: 36 3/4 X 22 Discount $ ($21.48) ($21.48) Frame Size: General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam ne 414 111 Final Wall Depth: insulated "r Frame Perimeter (inches): Exterior Color / Finish: White I ( ) Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (3W2H), White Net Price: $2,007.31 $2,007.31 Last Revision Date: Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Right Casement Frame Size: 36 3/4 X 62 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish: White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Hardware Options: Standard, Standard Roto Operator, Color Matched Screen: Full Screen, InView Grille: GBG, No, 3/4" Contour, Traditional (3W5H), White Wrapping Information: Perimeter Length = 242 ", Glazing Pressure = 205. EXTTRIMI O - PVC Ripped for stops Qty 1 MP -8 - Modified Pocket Installation up to 121 -130 Qty 1 UI wlwrap ITS -PVC4 - New interior PVC stop ripped from Qty 1 314 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 Printed on 10/18/2010 Office Order Copy Page 5 of 16 Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 4 1 1 Impervia, Casement, Impervia, Casement, 37.5 X 84.5, White List Price: $2,007.31 l2E■ Location: #4 F® Rough Opening: 38" X 85" 1: Non - Standard Size Fixed Casement Discount % = 0.00 % EMI Frame Size: 37 1/2 X 22 Discount $ $0.00 $0.00 %N■ Frame Size: General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam rc c+rl Final Wall Depth: Insulated mom Frame Perimeter (inches): 244 Exterior Color / Finish:White Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (3W2H), White Net Price: $2,007.31 $2,007.31 Last Revision Date: Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Right Casement Frame Size: 37 1/2 X 62 1/2 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish:White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Hardware Options: Standard, Standard Roto Operator, Color Matched Screen: Full Screen, InView Grille: GBG, No, 3/4" Contour, Traditional (3W5H), White Wrapping Information: Perimeter Length = 244 ", Glazing Pressure = 205. Installation Notes: At Verification Unit was Sized at 38.25 X 84.5 the Largest Width from the Factory is 37.5 Rip Stops Accordingly EXTTRIMIO - PVC Ripped for stops Qty 1 MP -8 - Modified Pocket Installation up to 121 -130 Qty 1 UI wlwrap ITS -PVC4 - New interior PVC stop ripped from Qty 1 314 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 Printed on 10/18/2010 Office Order Copy Page 4 of 16 Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 EXTTRIMI O - PVC Ripped for stops Qty 1 • EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 ITS -PVC4 - New interior PVC stop ripped from Qty 1 3/4 MP -6 - Modified Pocket Installation up to 101 -110 Qty 1 UI w /wrap Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 3 1 1 Impervia, Casement, lmpervia, Casement, 35.25 X 84.25, White List Price: $1,979.39 I ' ii1111111 Alen Location: Driveway Side c. Rough Opening: 35.75" X 84.75" 1: Non - Standard Size Fixed Casement Discount % = -1.41 % Frame Size: 351/4 X 22 Discount $ ($27.92) ($27.92) Frame Size: � F Si �� General Information: Standard, Duracast, Block Frame (3 1/4 "), Foam C.; A Final Wall Depth: Insulated All II ■ Exterior Color / Finish: White Frame Perimeter (inches): 239 Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Net Price: $2,007.31 $2,007.31 Last Revision Date: Grille: GBG, No, 3/4" Contour, Traditional (3W2H), White Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Right Casement Frame Size: 35 1/4 X 62 1/4 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish: White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Hardware Options: Standard, Standard Roto Operator, Color Matched Screen: Full Screen, InView Grille: GBG, No, 3/4" Contour, Traditional (3W5H), White Wrapping Information: Perimeter Length = 239 ", Glazing Pressure = 205. EXTTRIM10 - PVC Ripped for stops Qty 1 MP -8 - Modified Pocket Installation up to 121 -130 Qty 1 UI wlwrap ITS -PVC4 - New interior PVC stop ripped from Qty 1 3/4 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 Printed on 10/18/2010 Office Order Copy Page 3 of 16 Customer: George Houck Quote Description: 739 Impervia 413 - 584 -1100 Order Number: 739J3KL061 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price • 1 1 1 Impervia, Casement, Impervia, Casement, 21.75 X 84.5, White List Price: $1,557.31 I •il Location: Driveway Railing t 11 Rough Opening: 22.25" X 85" 1: Non - Standard Size Fixed Casement Discount % = - 19.15 % Frame Size: 21 3/4 X 22 Discount $ ($298.27) ($298.27) 1 41 Frame Size: General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam >uc Final Wall Depth: Insulated 7 ■ Exterior Color / Finish: White Frame Perimeter (inches): 213 Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (2W2H), White Net Price: $1,855.58 $1,855.58 Last Revision Date: Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Fixed Casement Frame Size: 21 3/4 X 62 1/2 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish:White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (2W5H), White Wrapping Information: Perimeter Length = 213 ", Glazing Pressure = 205. EXTTRIMIO - PVC Ripped for stops Qty 1 EXTTRIM8 - New exterior trim 1 X 4 PVC Qty 1 ITS -PVC4 - New interior PVC stop ripped from Qty 1 314 MP -6 - Modified Pocket Installation up to 101 -110 Qty 1 UI wlwrap Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 2 1 1 Impervia, Casement, Impervia, Casement, 23.75 X 84.5, White List Price: $1,583.01 I ■ 11 Location: Driveway Railing r. 1 Rough Opening: 24.25" X 85" 1: Non - Standard Size Fixed Casement Discount % = - 17.22 % Frame Size: 23 3/4 X 22 Discount $ ($272.57) ($272.57) F rame Size: ( �� General Information: Standard, Duracast, Block Frame (3 1/4 "), Foam ac Final Wall Depth: Insulated Exterior Color / Finish:White Frame Perimeter (inches): 217 Interior Color / Finish: White Interior Assembly Type: Branch Assembled Glass: Insulated Tempered Low E Advanced Argon Gas Net Price: $1,855.58 $1,855.58 Last Revision Date: Grille: GBG, No, 3/4" Contour, Traditional (2W2H), White Horizontal Mull 1: FieldMull, Standard (Horizontal Field) (0 ") 2: Non - Standard Size Fixed Casement Frame Size: 23 3/4 X 62 1/2 General Information: Standard, Duracast, Block Frame (3- 1/4 "), Foam Insulated Exterior Color / Finish:White Interior Color / Finish: White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Grille: GBG, No, 3/4" Contour, Traditional (2W5H), White Wrapping Information: Perimeter Length = 217 ", Glazing Pressure = 205. Printed on 10/18/2010 Office Order Copy Page 2 of 16 Office Order Copy N Branch Number: 73900 Order Number: 739J3KL061 10 • (' f 0 ® Window Store Name: Quote Number: 2096594 Quote Description: 739 Impervia 413- 584 -1100 Project Name: Houck George 197 N Elm Street Northampton MA 01060 Customer Information Deliver To Address Order Information George Houck Lot # Sales Rep Name: Lukomski, Adam Cust Delivery Date: 11/17/2010 Address: Business Segment: Retail Quoted Date: 10/8/2010 197 N Elm Street 197 N Elm Street Market Segment: Single Family Replacement Contract Date: 10/18/2010 Order Type: Installed Sales Booked Date: Effective Discount: - 3.547% Earliest LRD: NORTHAMPTON, MA 01060 NORTHAMPTON, MA 01060 Commission Split: Lukomski, Adam - 100% Contact Name: County: HAMPSHIRE Tax Code: MASS Tax Exempt #: Payment Terms: C.O.D. Customer PO #: Day Phone: (413) 584 -1100 Owner Name: Accessories Managed Accessory Delivery Date Mobile Phone: George Houck Fax Number: E -Mail: Owner Phone: (413) 584 -1100 Great Plains #: Customer Number: 4818411 Delivery Instructions: GPS, Brick House with White Vinyl Siding on the Sides, # 197 Marked Clearly on the House and on the Mail Box Installation Notes: GPS, Brick House with White Vinyl Siding on the Sides, # 197 Marked Clearly on the House and on the Mail Box Printed on 10/18/2010 Office Order Copy Page 1 of 16 SECTION8 - CONSTRUCTION SERVICES • 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : D & i 4 d I lJ g - License Number ASS 1 1w, � � � CTQArtt MA �1,.�O/ /Z& Address Expiration Date C r k k 4 / 1 3 - 7 7 2 - 0 / S 3 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ e lis 1Frocr(';k a , / 4 -,L7 Z7q Company Name Registration Number l_`-; S l� ri .5 �re� C ee -y, kiatat 000 i 3 2v ,26/ Z-- Address Expiration Date C) 0;4 Chllikk Telephone q E 7 72-0 IS 3 SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes . No ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [0] Brief Description of Proposed } Work: T c tin -j-i t , x ;AS/ 4.t4V lu,44 Ols i a Pk ate etr'41 iy■cpt aid l U 4 4 Alteration f xi in bedroom Yes _ No Adding u lies` No C h tt � of existing g �C g new bedr. • Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family .)( Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, Ge7_ -� , as Owner of the subject property , hereby authorize ?e (k TrhcifJC1 To( to act on my behalf, in all matters relative to work authorized by this building permit application. Kee ,f)( 1-01 CginiI 'd I D • z. /U Signature of Owner Date (kk , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and ff en (ties of perjury. O o Print Name 02/4 C• f /0- a Signature of Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information r Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES Q IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. ilk • • Department use only *' City of Northampton Status of Permit: r Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability �'� O � 0 I om 100 Water/Well Availability q, �, No MA 01060 Two Sets of Structural Plans pone 413 - 5137/240 Fax 413 - 587 -1272 Plot/Site Plans v Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE jt4FORMATION 1.1 Property Address: This section to be completed by office 1q7 / lm S e.-- Map Lot Unit Ai Or j-, 0 / 0 6 0 Zone Overlay District `� Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: c( 191 1,� ._� GC Q Id I fi Name (Pri Current Mailing Address: 4LS - ' 9 L_// C)Q *AT. , ( ' Telephone Signature 2.2 Authorized dent: - - Da kii a (,l'L Ae- t.c3 /14/1/04 ,.. ) ire(' 6,',,-,,,K4( 144 7 Name (Prin OccitQctu6A C Mailing Address: / 6 /...0 I 777 - Q /3 Sg a t ure i n Tel phone p SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee SS 00 2. Electrical � (b) Estimated Total Cost of �,,ll t�,l 0 Construction from (6) 22 / DO t/V 3. Plumbing Building Permit Fee 35 6 4. Mechanical (HVAC) 5. Fire Protection V (1 5) ) 22 < ( . 0 (3Y 6. Total = 1 + 2 + 3 + 4 + 5 Chec Number .,► This Section For Official Use Only 1 3 Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date I ! 1; 9 y am` BP- 2011 -0392 GIS #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP- 2011 -0392 Project # JS- 2011- 000651 Est. Cost: $22500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 7797.24 Owner: HOUCK GEORGE F Zoning: URA(100)/ Applicant: PELLA PRODUCTS, INC AT: 197 NORTH ELM ST Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON :10/28/2010 0 :00 :00 TO PERFORM THE FOLLOWING WORK :INSTALL REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 10/28/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner